Chocolate Makers Fortify Cocoa Snacks for Health

Action Points

Inform patients that standard commercial chocolate is not the flavanol-rich cocoa touted in recent studies. Commercial chocolate is high in calories, fat, and sugar and does not contain significant amounts of flavanols and no sterols.

Advise patients to be cautious when introducing new foods, such as CocoaVia to their diet. Although CocoaVia contains no trans fat and is fortified with flavanols and sterols, it contains approximately 100 calories per bar and there is no scientific proof the product itself can help reduce the risk of cardiovascular disease.

But don't call them candy bars, insist the confection word police at Mars, Inc. They are flavonol- and sterol-rich snacks.

Mars has been on the heart healthy trail ever since some European researchers began to report cardiovascular benefits for special formulations of dark chocolate that are rich in flavonols and sterols.

Several studies have suggested that flavonols can improve endothelial function, while sterols may help lower total cholesterol. Critics, however, note that chocolate also carries calories, and Americans are fighting an obesity epidemic.

With cardiovascular disease the nation's number one killer, Mars is betting that its new product line, CocoaVia, which is just hitting the health food aisles in grocery stores, will convince consumers that chocolate can be good for their hearts.

"This is not a story about chocolate," said Harold Schmitz, Ph.D., chief science officer of Mars. Chocolate bars are loaded with chemically-treated cocoa butter fat and sugar, he said. "This is science and this is a story about cocoa flavanols. That's very different than a standard chocolate bar product. It's really reinventing cocoa and taking it in an entirely different direction. I think it's important we make the distinction."

CocoaVia comes in eight different flavors and each 22-gram bar contains 100 mg of flavanols and between 1.1 and 1.5 grams of sterols. They have between two and 11 grams of fat and 80 to 140 calories. For example, the CocoaVia Blueberry & Almond Chocolate Bar has 100 calories, six grams of fat, and 12 grams of carbohydrates. None of the bars contains trans fat.

Mars recommends eating two bars per day to achieve the full benefit. A company spokeswoman said the amount of sterols in these bars could help lower cholesterol by 10% if the bars are consumed consistently.

Products like CocoaVia are "giving the consumers something that's desperately needed," said Naomi Fisher, M.D., the director of hypertension services at Brigham and Women's Hospital in Boston. Dr. Fisher, who has received research support from Mars Inc., said her patients frequently ask her about how they can use cocoa and dark chocolate to improve their cardiovascular health.

A recent study from Tufts and published in Hypertension,Journal of the American Heart Association, found 3.5 ounces of flavanol-rich dark chocolate associated with an average 11.9 mm Hg drop in systolic blood pressure and an 8.5 mm Hg drop in diastolic blood pressure. The study also showed dark chocolate lowered total cholesterol and improved flow-mediated dilation. Studies like these indicate the current fascination with cocoa products is not a passing fad, Dr. Fisher said.

Mars is not the only candy maker seeking to cash in on marketing chocolate to the health-conscious.

Hershey has its own concoctions in the works. The company would not comment on CocoVia or talk specifically about its own chocolate pipeline. However, Debra Miller, Ph.D., a senior nutrition scientist at Hershey said, "I think it's safe to say we will have products with flavanols."

A Hershey-funded study at Yale used ultrasound technology to compare the effects of Hershey's Extra Dark chocolate, which is high in flavanols, with a low-flavanol placebo on the arterial function of 45 moderately overweight adults. The findings showed 74 grams Hershey's Extra Dark, which is made with 60% cacao dark chocolate, improved blood flow and blood pressure. Seventy-four grams contained about 420 calories.

Mars said CocoaVia is not meant for obese patients who are at risk for cardiovascular disease, but for healthy individuals who want to reduce their risks. But at an average of a 100 calories a pop and with the company recommending two bars a day to achieve the health benefits, some nutrition experts have their doubts about CocoaVia.

"We have an obesity epidemic," said Alice Lichtenstein, D.Sc., who chairs the nutrition committee for the American Heart Association and is a professor of nutrition science and policy at Tufts. Just adding 100 calories a day to one's diet without increasing energy expenditure adds up to an extra pound of weight in 36 days, she said.

"It means something else has to come out of the diet, and candy may not be the best way to add healthful compounds or heart-healthy compounds," Dr. Lichtenstein said. "There are better ways of getting those compounds that aren't associated with calories. For most of us, we don't have discretionary calories."

It's still unclear whether it's solely the flavanols that have the effect on endothelial function or if it's a cluster of compounds working together in the cocoa that's producing this effect.

"We're still in our infancy of what chemicals do what," Dr. Fisher said.

Critics have suggested that the marketing is getting ahead of the science, but corporate scientists agree that whatever compounds go into the cocoa products, they should not to be mistaken for pharmacotherapy.

"We test chocolate, not molecules," said Dr. Miller of Hershey. "They don't want us to science it up too much. People don't want to see their chocolate become too medicinal."

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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